This study examined changes in possession of guideline-recommended
medication among three groups of New York State Medicaid
enrollees with severe mental illness: those who received an involuntary
outpatient commitment order, voluntary enhanced services, or
neither of these interventions.

Methods:

An observational study was
conducted with New York State Medicaid claims data for enrollees with
bipolar, schizophrenia, or schizoaffective disorders in New York City,
Long Island, and the Hudson River Valley regions from 2000 to 2005
(N=7,762). With adjustment for clinical and demographic characteristics,
logistic regression models predicted the probability of a monthly
medication possession ratio (MPR) ≥80% for medications recommended
by expert guidelines or by the U.S. Food and Drug Administration
for the indicated psychiatric diagnosis. Separate models were fit by region
and for patients who ever received assisted outpatient treatment
(AOT), voluntary enhanced services but never AOT, or neither treatment.

Results:

In all three regions, for all three groups, the predicted
probability of an MPR ≥80% improved over time (AOT improved by
31–40 percentage points, followed by enhanced services, which improved
by 15–22 points, and "neither treatment," improving 8–19
points). Some regional differences in MPR trajectories were observed.

Conclusions:

After New York implemented AOT and increased community
resources for enhanced services, guideline-recommended medication
possession improved among Medicaid enrollees with severe mental
illness—even among those who never received these interventions
or services.

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